S3 M7 Cellular Regulation Flashcards
Hematopoieses
Rapid continuous turnover of blood cells
Leukemia
Hematopoietic malignancy of the a particular blood cell
can be granulocyte, lymphocyte, erythrocyte or megakaryocyte
Leukemia defects originate in
hematopoietic stem cells
the myeloid
lymphoid stem cells
myeloid
nonlymphoid blood cells
RBCs, platelets, mast cells, macrophages, WBCs
Types of leukocytes
eosinophils
basophils
monocytes
go out of whack with leukemia
Acute myeloid leukemia AML 101
occurs before 45y
Most common nonlymphocytic leukemia
Death chances increase with age
Death is usually from infection of bleeding
Manifestations of AML
Acute myeloid leukemia
Neutropenia - fever and infection
Anemia - fatigue dyspnea pallor
Thrombocytopenia - petechia, ecchymoses, bleeding tendencies
AML and manifestations inorgans
Pain in liver or spleen from enlargement
Bone pain from marrow expansion
Hyperplasia (enlargement) of gums
Hyperplasia of synovial space of joints
Diagnostics of AML
CBC - v in erythrocytes and platelets
v in Leukocytes
Bone marrow analysis - 20% increase in immature leukocytes aka Blast Cells Hallmark of diagnosis
AML treatment
Aggressive chemo - induction therapy (hospitalization for weeks)
results in low ANC
Packed RBCs and Platelets for ANC
G-CSF or GM-CSF - promote granulocyte and macrophage growth
Treatment for APL
All-trans retinoic acid - prevents blast cells from proliferating at an immature age
+ Arsenic trioxide
Anthracycline for those at risk of relapse
Absolute neutrophil count
precise calculation of the number of circulating neutrophils
DROPS in AML
Consolidation therapy
Done to reduce the chances of recurrence of leukemia
usually contains cytarabine
HSCT
Hematopoietic stem cell transplantation
+ Aggressive chemo
+ Radiation therapy
Goal is to DESTROY patient hematopoietic function
PT is then “rescued” by the infusion of normal HSCT
Most common bleeds in AML
GI
Pulmonary
Vag
Intracranial
DIC is common, more so with APL
As tumors die uric aid and phosphorus will increase. Monitor
Kidneys
Chronic Myeloid leukemia CML 101
Pain in Liver Spleen and Long bones - excessive leukocyte proliferation
SOB, confusion - due to too much leukocytes
3 stages of CML
Chronic
Transformation
Acceleration (blast crisis)
Chronic - low complications
Transformation and acceleration - increase in complications
Rx treatment for CML
Tyrosine kinase inhibitors
Imatinib
HSCT if not Rx progress
Transformation phase CML S/S
bone pain, fever, weight loss
Spleen will enlarge
Anemia/Thrombocytopenia
Acceleration (blast crisis) phase CML S/S
Same as AML
Induction therapy
Nursing management of CML
PCR to detect levels of BCR-ABL molecules
Major molecular response Benchmark for determining efficacy
Biggest issue with taking tyrosine therapy is ADHERENCE, STRESS importance of taking meds
Acute lymphocyte leukemia ALL 101
uncontrolled proliferation of immature B lymphocytes and T lymphocytes
Common in kids and those over 50y
S/S of ALL acute lymphocyte leukemia
v in granulocytes erythrocytes and platelets
^ in IMMATURE leukocytes
Highest rate of organ infiltration (liver spleen bones)
Attacks CNS - Cranial nerve palsies and Headache/V
Treatment for ALL
Chemo
Cranial irradiation if CNS
Rx for ALL
Corticosteroids
Vinca alkaloids
Anthracyclines
HSCT in worst case
These meds are toxic to the LIVER
Due to corticosteroid use in ALL complications may include
Resp infection
Avascular necrosis
Chronic Lymphocyte Leukemia CLL
Most prevalent type of adult leukemia
Familial predisposition exists
Chronic Lymphocytic Leukemia CLL patho
B lymphocyte malignancy
Mature cells escape apoptosis
Excessive accumulation of cells in the marrow and circulation
How many stages of CLL
4
1st stage of CLL
increase in lymphocytes exceeding 100,000/mm
In CLL, malignant cells are so small that they don’t affect
Pulmonary or cerebral function
Mostly affects lymph nodes and spleen
Immunophenotyping of circulating B cells
Critical to establish diagnosis and gauge prognosis of CLL
CLL autoimmune complications
Anemia
Thrombocytopenia
S/S of CLL
^ lymphocytes
Enlargement of lymph nodes
Enlargement of spleen
CLL “B symptoms”
Fever
Drenching sweat (especially at night)
Unintentional weight loss
Watch for Infections
Calculate functional status
Life expectancy independent of CLL
Creatinine clearance
ADLs
The better you score the more aggressive therapy you can handle
Treatment for CLL
Immunotherapy and Chemo
If not effective, Kinase inhibitors
Side effect of Fludarabine used in CLL
Bone marrow suppression - neutropenia, thrombocytopenia etc.
Side effects of Alemtuzumab
Drop in B and T cells = high risk for infections
Basic Nursing focus with leukemia
Infection and bleeding
Mucositis management
Nutrition and Leukemia
Small frequent feedings
soft texture
moderate temperature
Daily body weight
Pain and leukemia
Tylenol
Sponging with cool water NO COLD
PCA (patient controlled analgesia)
Fatigue and leukemia
Stationary bike
Physicals therapy
Just sitting up during the day will improve tidal volume
F/E and leukemia
Measure I&Os - dehydration and fluid overload
CBC BMP - lytes, BUN, creatinine, hematocrit
K and Mag are frequent IVs
With leukemia don’t forget to manage
Hygiene
Anxiety and grief
Spiritual well-being
Lymphoma
Lymph node tumors
Can involve spleen, GI tract, liver, bone marrow
2 types, Hodgkin and non-Hodgkin
Hodgkin lymphoma 101
Rare, high cure rate
happens between 15y and 34y or over 60y
familial pattern
Hodgkin lymphoma patho
Single node origin
Reed-Sternberg Cell - huge immature lymphoid tumor cell, Core cell of the disease, all benign cells around it just support it.
S/S of hodgkin lymphoma
Enlargement of one or more lymph nodes on neck, Painless and firm
Cervical, Supraclavicular and mediastinal nodes most common
Mediastinal mass may be large enough to close trachea and cause dyspnea
Organ S/S of hodgin lymphoma
Organ compression
Pulmonary effusion
Jaundice
Abdominal pain
Bone pain
B symptoms
B symptoms
Fever
Drenching seats
Weight loss
Erythrocyte sedimentation rate
Rate of RBC settling - elevation indicates hodgkin lymphoma
Diagnosing hodgkin lymphoma
Lymph node biopsy
Finding of the Reed-Sternberg cell
Staging
Assessing the extent of hogkins
like b symptoms
lymph node palpation
spleen and liver size
Xray and CT
PET positron emission tomography
Treatment for hodkins
Chemo plus meds
MoAb - attack’s Reed Sternberg but also attacks T and B cells
Hodgkins survivors are at risk of
Other cancers
Cardiovascular diseases
Endocrine system problems
Nursing management of hodkins
Check for secondary malignancy
Decrease tobacco, alcohol and exposure to carcinogens/excessive sunlight
non-hodgkin lymphoma NHL
neoplastic excess growth of lymphoid tissue
B and T lymphocyte overgrowth
As opposed to hodgkin, in NHL tissues are largely infiltrated
spread is unpredictable
NHL is the _ most common cancer
6th
S/S of NHL
Lymphadenopathy (swelling of lymph nodes) is most common
B symptoms
Masses can mess with organ function like breathing problems, renal problems, nausea
Indolent vs Aggressive NHL
Indolent -small cells distributed in circular pattern
Aggressive - large cells distributed in diffuse pattern
Staging for NHL
CT PET
Bone marrow biopsies
Cerebrospinal fluid analysis
Predictors for lymphomas
IPI and FLIPI
R CHOP
MoAb + chemo
Aggressive treatment for Lymphomas
In Lymphoma has CNS symptoms treat with
Cranial radiation
Intrathecal chemo
Other therapies for lymphomas
Immunotherapy
Radiopharmaceutical agents
HSCT
Most common treatment for NHL
Chemo and radiation
Nursing management for NHL
Fatigue due to chemo and radiation
Risk of infection due to suppression of immunity
Teach pt about monitoring S/S of infection
Screen survivors regularly
NHL survivors are faced with handling
Fatigue, depression, anxiety, cardiac and pulmonary toxicity
Recommendations for cancer survivors
Good BMI
Smoking cessation
Improve nutrition
150 min of aerobic activity per week
Leukemia is a disease of the
Bone marrow
Metastasis
Spread of cancer to other sites
ALL and AML occur more commonly in
Children
Consolidation
Increasing meds and doses to treat leukemia
Med maintenance time for kids after leukemia
2-3 years
Leukemia risk factors
Male gender
2-5 y
White
fam hist
Salmon colored or blue gray papular nodules
Will be subq and rubbery
Indicate AML
Increased work breathing
Facial edema
Venous engorgement
Signs of NHL
Pain management system
3 steps
1 nonopioid/adjuvant
2 mild/moderate opioid and nonopioid/adjuvant
3 severe opioid and nonopioid/adjuvant
Fatigue with cancer can be caused by
Pain/pruritis
Malnutrition
Lyte imbalance
Impaired physical ability
Uncertainty/anxiety
Stomatitis is a form of
Mucositis
How to treat mucositis
Palifermin IV
Radiation therapy lead to skin
Integrity issues
Cancer and hair
Alopecia
begins 2 to 3 weeks after chemo and radiation starts
If a tumor metastasizes at the epithelium this lead to
Malignant skin lesions
Monitor lesions for size, appearance, pain, drainage and evidence of infection
Cancer Survivorship monitoring
follow ups
approaches to treat symptoms
rehabilitative needs
late effect monitoring
surveillance and screening for new cancers
Pain management in pallative care
have analgesics on a schedule instead of PCA
Palliative care teaching
Setting realistic goals
using energy conservation methods to accomplish tasks and activities that the PT values most
Malnutrition is greater in Crohn’s or Ulcerative Colitis
CROHNS may be on test
Leukemia is a cancer of
BLOOD
Bone marrow is where blood cells are
Created
Liver and spleen and extramedullary hematopoiesis?
Overgrowth of immature blood cells
Fills the blood and THEN the bone marrow
This is called
Leukemia
Anemia occurs with leukemia because immature cells
S/S
Push all cells out of space
This causes FATIGUE AT REST may be on test
Blood labs with leukemia
v RBC
v Platelets
^ WBC
Myeloid in AML means the cells that cause issues are
RBCs
Platelets
5 main WBCs
neutrophils, eosinophils, basophils, etc.
Onset of AML
Abrupt
What enlarges with AML
What decreases with AML
Bones Liver Spleen (this is where cells form)
Neutropenia, low platelets, low energy (fatigue)
Main complications of AML
Infection
DIC
Tumor lysis syndrome
Onset of symptoms in Chronic myeloid leukemia CML is
SLOW
Blast cells = neutrophils are affected by
CML
Bone marrow spleen and liver enlargement
increase in leukocytes
are generally present in
ALL Leukemias
CML patients have B symptoms which are
Fever
night sweats
weight loss
fatigue
Tyrosinekinase inhibitors TKI are used to
Philadelphia cell leukemia
Lymphocytic leukemia involves what cells
WBCs only
T Cells
B Cells
NKs
and basic WBCs
Strong familial predisposition is associated with
Age
Mainly affects what cell
CLL chronic lymphocytic leukemia
72
B Cell
Lymphoma is abnormal growth of what
Lymph nodes START
can travel to spleen, GI tract, liver, bone marrow
Do lymphomas have pain
Do they have itching
NO, may be on test
YES
Do Lymphoma PTs have B symptoms
YES
Increase in chemo intensity =
increase in positive outcomes BUT ALSO increase in toxicity
More common lymphoma
nonhodgkins
nonhodgkins cells can travel to
any part of body
Infection monitoring with lymphomas
CBC q day
ANC key indicator
Avoid invasive procedures (foleys, injections)
Hand washing
Obtain culture BEFORE antibiotics
Can leukemia pts get flowers
NO
Due to low platelet counts Leukemia pts may have internal bleeding indicated by
HR will go up
BP will go down
Altered mental status
Mucositis, a side effect of chemo
care
ulcers anywhere down the GI tract
No coffee, tobacco, alcohol, hot foods
Oral hygiene, NS wash q1-4h
Unless pt is eating, remove dentures
pain meds are better given
early in cycle
Ductal carcinoma in situ DCIS
Proliferation of malignant cells in milk duct WITHOUT invasion of surrounding tissue
Assessment for DCIS
Accurate diagnosis
Size and grade assessment
Margin evaluation
Mutation in BRCA 1 or BRCA 2 indicates
increased risk for breast cancer
Chemopreventives for breast cancer
tamoxifen
raloxifene
Prophylactic mastectomy
Total mastectomy of a breast at risk
Reasons to get
Fam history, BRCA, LCIS, previous cancer
Breast cancer is usually found in the
upper outer quadrant
S/S of breast cancer
nontender fixed hard mass
skin dimpling, nipple retraction, skin ulceration
BC prognosis is based on
size
spread to other areas
Preoperative nursing interventions
Know difference between ALND (axillary lymph node dysection) and SLNB (sentinel lymph node biopsy) and treatment options
Emotional support
promote decision making
Postoperative nursing interventions
Pain and discomfort relief THERAPY
Promote positive body image
Promote coping
improve sexual function
Monitor for complications LYMPHEDEMA
When are post surgery drains removed
When drain output is less than 30ml in 24h
Complications of breast surgery
Lymphedema
Hematoma/Seroma
Infection
Range of motion exercises should be performed at what rate
3 times a day
20 min session
Brachytherapy
radiation delivered via internal device
given over 4 to 5 days as opposed to regular radiation
which is 5 to 6 weeks
Nursing management for radiation therapy
Used mild soap and minimal rubbing
No perfumes/deodorants
Hydrophilic lotions
Antipruritic soap
Avoid tight cloths
To minimize chemo side effects pts may be given
hematopoietic growth factors
granulocyte colony stimulants
Trastuzumab
Binds specifically to HER-3 protein preventing cancer
Most significant risk factor for colorectal cancer
old age
S/S of colorectal cancer
change is bowel habits
blood in or on stool
anemia anorexia
weight loss or gain
Dull abdominal pain and melena(dark stool)
colorectal cancer
Screening for colorectal cancer
colonoscopy
Complications of butt cancer
obstruction
hemorrhange
Old butt cancer patients may report fatigue due too
low iron
med to prevent butt cancer
aspirin
Surgeries for butt cancer
segmental resection
perineal resection
Temp/permanent colostomy
Colonic j-pouch
With butt cancer, chemo usually starts at stage _
unless your is messed up at stage
3
MMR, 2
Butt cancer preop nursing care
Nutrition
Infection prevention
FV balance
Butt cancer postop nursing care
Nutrition
Wound care
Monitor for complications, Rectal bleed emergency - hemorrhage
Most common cause of lung cancer
inhalation of carcinogens
cigs
2 categories of lung cancer
Small cell lung cancer SCLC
non-small cell lung cancer NSCLC
S/S of lung cancer
Cough or change in chronic cough MOST common
Dyspnea
recurrent fever
Diagnostics for lung cancer
Chest xray
CT
Sputum cytology
MRI/PET
surgery for lung cancer
Resection
Complications of lung surgery
resp failure
need for mechanical ventilation
infection
complications of lung radiation
v in cardiopulmonary function
pulmonary fibrosis
heart problems
complications of lung chemo
pneumonitis
pulmonary toxicity
Nursing management for breathing with lung cancer
Clearance techniques
suction
sit upright
Genes associated with prostate cancer
HPC 1 BRCA 1 BRCA 2
S/S of pros cancer
urinary obstruction
blood in urine or semen
painful ejaculation
Symptoms of metastases of prostate cancer
backache
hip pin
perineal and rectal pain
Assessment for pros cancer
DRE
serum PSA
ultrasound guided TRUS
Score to determine treatment for pros cancer
gleason
pros cancer and vaccines
therapeutic vaccines kill existing cancer cells
provide future immunity
Surge management of pros cancer
radical prostatectomy
may have impotence
radiation for pros cancer
brachytherapy - radiation
ADT
androgen deprivation therapy - castration - increases morbidity
hormone therapy
Hormone therapy for pros cancer
LHRH agonists
Antiandrogen receptor agonists
Other pros cancer therapies
cryosurgery
TURP
Pain management
Skin cancer causes
UV exposure
skin Basal cell carcinoma S/S
small waxy nodule
rolled translucent pearly borders
skin Squamous cell carcinoma
from epidermis
Invasive and metastasizing
SCC S/S
rough thickened scaly tumor
may or may not bleed
Surgical skin cancer treatment
Mohs micrographic surgery - most accurate, removes layers
Electrosurgery - current burn it
Cryosurgery - deep freezing the tissue
Topical treatment for skin cancer
5 aminolevulinic acid + PDT
ALAPDT
Teaching for skin cancer
dressing changes and wound checking
monitor bleeding
emollient cream for dryness
follow up q3m for a year
Melanoma manifestation
dark red blue
irregular shape
1cm
itching ulcerations bleeding
rapid growth
2 phases of melanoma growth
1 wide
2 into skin
Diagnosing melanoma
Biopsy
Staging for melanomas
Tumor nodes metastasis system
Melanoma nursing intervnetions
Pain and discomfort
Reduce anxiety
Monitor complications
If cancer metastasizes in another area…
that is where you will have problems
How often after 40 are mamograms and clinical breast exams done
every year
When do colonoscopy’s and fecal occult blood start
age 50 q10y
TNM
staging
t - tumor
tx t0 tis in situ
n - node
nx n0 n1
m - metastasis
mx m0 m1
Tumor grading
gX g1 g2 g3 g4 g5
Well differentiated is
Undifferentiated is
tumor look line normal cell GOOD
no similarity BAD
Step 1 in tumor treatment
surgery removal topical burns/cryo
Types of tumor excisions
surgery and biopsy
To admin chemo you need
can you crush chemo drugs
special certs
double checking by 2 nurses
NO
Chemo complications
immunosuppression
NV Anorexia
Alopecia
Oral effects - mucus lining thinning mucositis/stomatitis
Anemia/thrombocytopenia
How to chemo meds work in terms to cell life
they affect different life stages of cell procreation mitosis
Radiation
ionizes and targets tissue cells
Skin will be Sun Burned - expected side effect
bad radiation side effects
Weeping
drainage
ulcers
Do you put lotions on radiation
how is radiation give
NO
fractions - given in centigrade of whole
if prescribed 500 centigrade, given 20 centigrade per a session
Protection with radiation
ware dosimeter and protective equipment as a nurse
let pt know to stay away from pregos and spouse
visiting times down to 30 min 6 foot distance
Documentation with radiation should be
Meticulous
what time, what day, how much,
to know precaution
Internal radiation implant seeds will cause
radiation precaution to last longer
radiation ruins the taste of
red meat
lime or mint taste good
actinic keratosis
small red areas that grow scale and thick over time
Precursor to skin cancer
might be on test
3 types of skin cancer
scc - squamous, scaly lesions
bcc - basal, most skin cancer, small waxy nodules
melanoma - Most dangerous and spreading, Look like moles
ABCDE of melanomas
Asymmetry
Border irregularity
Color variation
Diameter over 6mm
Evolving
generally the more symmetry the better and vice versa
Mohs surger
continuing to burn or freeze post melanoma cites until biopsy comes up negative
+5 sunburn =
double the skin cancer risk
Where does lung cancer like to spread
brain and bone
Adenocarcinoma lung cancer -
more contained
Types of non-small lung cancer
adenocarcinoma
squamous
large cell
Small cell lung cancer is _ aggressive
MORE
best imaging for lung cancer
CT Scan
Planectomy lobectomy
removal of a lung or lobe
cancer option
Thoracentesis
removal of fluid from lungs
if bloody = cancer
lung cancer meds
bronchodilators
corticosteroids
Ductal vs lobular breast cancer
in milk ducts
in milk glands
Paget’s disease
cancer that starts at nipple
Areola is scaly red itchy and irritated
May be on test
1st degree relatives
if they have breast cancer so could you
mom sister
Diagnosing breast cancer basics
mammogram/ultrasound
BRCA
Prostate cancer is so slow that treatment can be delayed for up to
this can also lead to under monitoring
10 year
Prostate cancer is also linked with what mutation
BRCA
Early prostate cancer s/s
Hesitancy
weak stream
urgency
frequency
nocturia
prostate cancer likes to spread to
BONE
the lymph nodes
will hurt
PSA
prostate specific antigen
elevated is more than 4
do this BEFORE Digital rectal exam
EPCA =
prostate cancer
best indicator
Androgen deprivation therapy
hormonal therapy for prostate cancer
post prostate surgery procedure
CBI
continuous bladder irrigation
monitor color for progression
1000ml in should = 1000ml out
Avoid _ based mouth wash with mucositis
alcohol
will burn
4 components of survivorship
prevention/detection
surveillance or spread
intervention for consequences
coordination with specialists (care liaison)
When does cancer survivorship start
DIAGNOSIS
may be on test
Palliative care
Specialty in pain management
Care to make you comfortable
not the same as hospice
Hospice care
cure is no longer the goal
comfort for remainder of life
cancer pain in mostly what type
chronic
acute cancer pain
usually post surgery can become chronic
chemo pain
tissue necrosis neuropathies
radiation pain
skin, tissue, organ inflammation
Pain unrelated to cancer
preexisting migraines or arthritis that make pain worse
cancer pain is not irreversible it is
anxiety and pain increase…
controllable
each other in a cycle, may be on test
pain doesnt =
death
nursing interventions for pain
assess pain quality - duration location etc
assess influence factors - anxiety
other methods - acupuncture
use pain scale before AND after interventions
